Organization
MARY IMMACULATE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. USHA C RUDER M.D. (CHAIR, PATHOLOGY DEPARTMENT)
(715) 558-2714
Entity
Organization
Contact information
Practice address
24 NIGHT HERON DR, STONY BROOK, NY 11790-1108
(631) 689-5654
(718) 558-2166
Mailing address
152-11 89TH AVE., MARY IMMACULATE HOSPITAL ,, JAMAICA, NY 11432-1108
(718) 558-2714
(718) 558-2166
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
115646
NY
Other
Enumeration date
03/14/2007
Last updated
08/22/2020
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